HCPCS Code J3380

Official Description

Injection, vedolizumab, intravenous, 1 mg

Short Descr	Inj vedolizumab iv 1 mg
Related Drugs	Entyvio
Coverage	Special coverage instructions apply
Pricing Indicator(s)	51 – Drugs
MPI	A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code	YY – 1/01/2016
Processing Note	PUBLICATION 100.2, CHAPTER 15, 50.1.
BETOS	O1E – Other drugs
TOS Code(s)	1 – Medical care
Added Date	1/1/2016
Status Code	Excluded from Physician Fee Schedule by Regulation
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals
ASC Payment Indicator	Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
MUE	300
MUE	0
OTS Orthotic	No

JZ	Zero drug amount discarded/not administered to any patient
JA	Administered intravenously
EJ	Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GA	Waiver of liability statement issued as required by payer policy, individual case
JG	Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
KX	Requirements specified in the medical policy have been met
JW	Drug amount discarded/not administered to any patient
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
GW	Service not related to the hospice patient's terminal condition
X4	Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study
UD	Medicaid level of care 13, as defined by each state
TB	Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
GZ	Item or service expected to be denied as not reasonable and necessary
RT	Right side (used to identify procedures performed on the right side of the body)
GX	Notice of liability issued, voluntary under payer policy
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
LT	Left side (used to identify procedures performed on the left side of the body)
PD	Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
SA	Nurse practitioner rendering service in collaboration with a physician
25	Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
76	Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
BR	The beneficiary has been informed of the purchase and rental options and has elected to rent the item
JB	Administered subcutaneously